METABOLISM IN DISEASES OF BONES AND JOINTS 755 



series of cases, show a very slight, though probably insignificant, loss of 

 weight ( McCrudden ( c ) ) . 



Comparative studies of the fat metabolism, of the storage of fat, and 

 of the amount of oxygen used in cases of normal and castrated animals 

 show no differences. The feeding of ovaries, and ovarian extract, of 

 testes and testicular extract, have given likewise. negative results. Com- 

 plete balance studies, made by McCrudden (c) on adult male and 

 female dogs, before and after castration, show no effect on the metabolism 

 of nitrogen, sulphur, calcium, magnesium, or phosphorus. Less com- 

 plete metabolism experiments on puppies, and comparative studies of the 

 total amount of phosphate in normal and castrated animals, have given 

 likewise negative results. 



Furthermore, histological examination of the ovaries in osteomalacia 

 shows no changes. A number of such ovaries have been examined. Bulius 

 made a careful study of six cases and found no change. He was 

 obliged to reject findings, reported in an earlier paper of his own, in 

 which he alleged hyperemia and hyaline degeneration of the arterial walls. 



In this connection, too, we think of the cases of osteomalacia in young 

 women before the ovaries have begun to function, in old women after 

 the menopause, and especially in men. Such cases as the latter, though 

 rare, do occur. One of the bones analyzed by McCrudden came from a 

 young man with the disease. Among 360 cases of osteomalacia reported 

 by five writers, there were thirty-nine cases of the disease) in men 

 (McCrudden (e)). Without making a special search for all cases, Mc- 

 Crudden (0) found ten cases of the disease reported during the last twenty- 

 five years in childless, unmarried women the diagnosis being confirmed 

 in some cases by autopsy and nine cases in men, four of which were 

 confirmed by autopsy. I have seen two cases in childless, unmarried 

 women, and two cases in men. 



The temporary nature of the good results of castration on the clinical- 

 course of the patient studied by McCrudden led to a careful examination 

 of the literature td see how frequently this operation resulted in permanent 

 cure in other cases (e). An examination of the clinical results of cas- 

 tration in osteomalacia naturally began with the cases of Fehling. By 

 1895, the date of his last report, Fehling had reported fourteen cases of 

 osteomalacia treated by castration (d). Of these, but six were well 

 three years after the operation. Two were not cured, and one of them, 

 after showing temporary improvement, later, as in McCrudden's case, then 

 relapsed. The others either died or could not be traced. Von Winckel 

 has reported three cases, of which one was improved after castra- 

 tion. Polgar tried the operation in six cases; a cure followed in all 

 but two. Wheaton, Latzko, and Poppe have each reported one case, 

 in which castration was carried out without any effect on the 

 disease. In one of two cases, Neumann (i) failed to help by cas- 



